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Information from your health plan about COVID-19 (coronavirus disease)

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Individual and family document library

We try to minimize paperwork. But sometimes you need a form or other information. And when you need it, you want it to be convenient. We have created a document library to give you easy access to the most requested forms.
  • 2021 Individual and Family Health Insurance Application

    Complete this form to apply for health coverage

    Download

  • 2021 Individual and Family Policy

    Provides specific coverage details for your policy

    Download

  • 2021 Select Customer Guide

    Brochure outlining our Select plan, including the service area, provider network and plan options. Helpful for Marketplace plan shopping

    Download

  • 2021 Select Member Handbook

    A quick-start guide for Select members to understand their health plan and find the information they need

    Download

  • 2021 SimplyOne Customer Guide

    Brochure outlining our SimplyOne plan, including the service area, provider network and plan options. Helpful for Marketplace plan shopping

    Download

  • 2021 SimplyOne Member Handbook

    A quick-start guide for SimplyOne members to understand their health plan and find the information they need

    Download

  • HIPAA Authorization to Use and Disclose Protected Health Information

    Use this form to designate individuals you choose to have access to your health information

    Download

  • Member Prescription Drug Reimbursement Request

    Complete this form to submit a prescription drug reimbursement claim

    Download

  • Póliza Individual y Familiar de 2021

    Proporciona detalles de cobertura específicos de su póliza

    Download